This essay captures the political-economic reality of our housing crisis perfectly. I think this is your best, most clear writing I've read from you so far. We need everyone in the homelessness industry to read this essay - politicians, government officials, NGO leaders, housing investors, and policy makers. This is the real Truth of the streets. Well said Kevin. Thank you for your insight, clarity, and conviction for the people who need more help than we currently have to give them. Keep up the good fight.
I don't know how to get through the impasse of voluntary. A friend of mine has a son that just came home from 3 weeks in the mental health hospital. He had turned off the heat to his apartment and threw away his phone. He returned to his apartment over the weekend and is supposed to go to an out patient support group next week. He is going to be having someone who picks him up and takes him home so maybe that will help get around the voluntary pitfall. I am hoping so. He is better with medication but before was not able to live independently.
There's a Norwegian movie from 2008, called "Lars", about a man who has lived forty years without ever leaving his mom's apartment. When she dies, the authorities come to clear it out and find him hiding in a closet. The rest of the movie follows him as he is rehabilitated, with consistency and patience, as he moves from an institutional setting to a halfway house and finally to his own apartment with a roommate.
It's probably expected that we have become asylumphobic, due to the horrors, including lobotomies, inflicted on people in mental hospitals for so long, as documented in another great film, "One Flew Over the Cuckoo's Nest", among others.
However, it's long past time to recognize that when people regress to certain states, for whatever reason, they can't just jump back into the stressful and complex nature of society today, but they also aren't always willing to seek help or treatment.
Interventions don't have to be traumatic. They can show we care, because healthy boundaries are constructive, not destructive.
Can we build a network of transparent institutions that mirror the structure of the Norwegian model, at least the spirit of the one that is depicted in the movie or existed in 2008? If so, could we address the voluntary-only nature of laws that govern treatment?
The biggest problem with institutional charity is that everyone deriving an income or career from the charity is NEGATIVELY incentivized to eliminate the target problem. For anyone working at the “housing bureau” to house the homeless, elimination of homelessness means eliminating their job or even career. Ain’t gonna happen. Institutional charity will NEVER succeed until there is devised a mechanism to POSITIVELY incentivize the workers who eliminate or reduce the targeted problem.
But as the graphic shows, that offer of “personalized support” is voluntary- means the person being housed does not need to engage. And the entity offering the support does not get to require.
Not sure if the photos are yours or Tara Faul’s but these images are an important supplement to your message.
The man with new pants and shoes and a blanket over his head. The woman with the cat, the love bracelet, and multiple (presumably unopened) hygiene bags.
So many humans on the street getting stuff from unconnected “services” that gets lost without the structure and human connection that helps them hold it together.
Thanks for writing about a tough problem. The best solution is short term civil commitment in local hospitals which litigates the liberty interests of the severely mentally ill versus community interests for safety, civility, the capacity to intervene for the humane welfare of those who are severely mentally ill, and beauty in the public square. This will get those who are severely ill help for up to six weeks, the opportunity to get clean, fed, housed temporarily, talked to, sometimes detoxed, sometimes medicated, and to receive care for physical afflictions as well. No one wants to care for these people. The legal profession has advocated for them rotting with their rights on which is what we see daily on the streets. For years the legal profession has buried its head in the sand not wanting to address this public emergency. The medical profession sees them as obstinant, non compliant, sometimes aggressive, and so complex medically and psychiatrically that it is too much for them to even consider treating. That is why they need confinement involuntarily in local hospitals, that have access to other medical specialists, can be managed by psychiatrists on psychiatric units. The police want no part of trying to take them to a hospital when they refuse to go because they risk their lives. Remember they are armed with needles that the county passes out to them daily which can be used to stick officers and possibly infect them. Why would the police take these severely ill people to the hospital when they will be released in a few days and back on the street. The prosecutors would like to refer them for a meaningless psychiatric evaluation or better to have them get sent to the state hospital for interminable evaluations just to get them off the streets. Who wants to put these people in jail when they break public laws? First you have to get them to jail which is very dangerous and might take six officers who risk getting injured. Then the prosecutor won't charge them or jail them. It is easy to see why people would just want to house them, but that will fail because they will likely burn and destroy and not follow any treatment recommendations.
I am not against approaching this problem from all kinds of angles. Compulsive responsible outreach to try and get their cooperation, philanthropic housing for those who are severely ill after hospitalization and need 24/7 caregivers, assertive case management through local community centers, detox on demand for those who voluntarily request it, punishment and jail time for those who break public laws. With the best of efforts, many of these people will still chose a lifestyle that shows a disregard for personal and social responsibility. We need a structure to deal with them, persistent efforts to get them cleaned up and mentally healthier with brief hospitalizations, and an intervention-oriented police capacity. It helps not to see them as victims, but as those who can choose health and reasonable social conformity. Ultimately, our forceful efforts should be seen for what they really are, which are interventions for the public good, and stop with the phony virtue. The expectation should be that these people should get it together both personally and socially here. We should foster that choice, though ultimately change is up to them. When they chose wrong there should be some consequences. As you know I am totally opposed to long term hospitalization as these individuals get worse with long term institutional care. No more going back to warehousing the severely mentally ill.
Have the local officials whose beliefs and decisions have made housing first a scandalously expensive failure ever been asked to account for the results in a way that wouldn’t let them dodge responsibility? If I had a list of names, office contact information and vetted talking points, I’d gladly do it in writing.
This is the most comprehensive and compassionate article of yours and as someone who is a year clean from substance use disorder and still working to improve my home status, I really appreciate you completing the discussion with a solution.
The hardest thing to accept is: you can’t make people do anything. The services have to be voluntary. I love the programs use incentives and require mental health services. The concept makes complete sense except you can’t force people in our free will society to combat their trauma or financial health. Force them to take medication, stop using substances or stop drinking. all there is to do is get them housed and meet people where they are at emotionally until they feel safe to eventually use the services. It’s really an overwhelming process going from homeless, traumatized addict to an emotionally stable housed person.
No one is truly free to make a choice when driven by mental illness and drug and/or alcohol addiction. We must lower the bar on civil commitment, take the money now granted to non-profits, which mainly pay their staff high salaries rather than cure homelessness, and build lock-down facilities where psychotherapy, drug rehab treatment, job skills, nutrition and so forth are provided to the homeless. It seems that even with the current criteria for civil commitment, many would be determined to be incapacitated enough to be taken in to such places where the patient would actually have a chance to get well. Some patients would resist but others would accept it and gradually gain a bit more freedom than those that resist. It's not realistic or compassionate to act as if someone in an irrational state of mind will make healthy responsible choices. Deinstitutionalization led to this crisis and many other factors such as state sponsored enabling feeds it. Handing out supplies merely helps the addicts stay homeless, keeping them alive to eventually waste away from self destructive lifestyles that also negatively impact those living around them and the environment.
This essay captures the political-economic reality of our housing crisis perfectly. I think this is your best, most clear writing I've read from you so far. We need everyone in the homelessness industry to read this essay - politicians, government officials, NGO leaders, housing investors, and policy makers. This is the real Truth of the streets. Well said Kevin. Thank you for your insight, clarity, and conviction for the people who need more help than we currently have to give them. Keep up the good fight.
The past is the past. Kevin speaks truth here. What he says is real.
Slogans never do much good, but instead of “housing first”, it might be better to use “responsibility first”……But that is too harsh for all of us.
I don't know how to get through the impasse of voluntary. A friend of mine has a son that just came home from 3 weeks in the mental health hospital. He had turned off the heat to his apartment and threw away his phone. He returned to his apartment over the weekend and is supposed to go to an out patient support group next week. He is going to be having someone who picks him up and takes him home so maybe that will help get around the voluntary pitfall. I am hoping so. He is better with medication but before was not able to live independently.
There's a Norwegian movie from 2008, called "Lars", about a man who has lived forty years without ever leaving his mom's apartment. When she dies, the authorities come to clear it out and find him hiding in a closet. The rest of the movie follows him as he is rehabilitated, with consistency and patience, as he moves from an institutional setting to a halfway house and finally to his own apartment with a roommate.
It's probably expected that we have become asylumphobic, due to the horrors, including lobotomies, inflicted on people in mental hospitals for so long, as documented in another great film, "One Flew Over the Cuckoo's Nest", among others.
However, it's long past time to recognize that when people regress to certain states, for whatever reason, they can't just jump back into the stressful and complex nature of society today, but they also aren't always willing to seek help or treatment.
Interventions don't have to be traumatic. They can show we care, because healthy boundaries are constructive, not destructive.
Can we build a network of transparent institutions that mirror the structure of the Norwegian model, at least the spirit of the one that is depicted in the movie or existed in 2008? If so, could we address the voluntary-only nature of laws that govern treatment?
How do we get from here to there?
The biggest problem with institutional charity is that everyone deriving an income or career from the charity is NEGATIVELY incentivized to eliminate the target problem. For anyone working at the “housing bureau” to house the homeless, elimination of homelessness means eliminating their job or even career. Ain’t gonna happen. Institutional charity will NEVER succeed until there is devised a mechanism to POSITIVELY incentivize the workers who eliminate or reduce the targeted problem.
Perfectly stated, here in VENETA we’ve provided housing and food, but we still have a problem because there is no treatment.
“Housing first” works only when it includes ongoing services.
The original Housing First model wasn’t “give someone an apartment and walk away.”
It was:
* Immediate housing with no barriers, PLUS
* Strong, long-term wraparound support.
Many current programs miss the second half — and that’s where people fall through the cracks.
But as the graphic shows, that offer of “personalized support” is voluntary- means the person being housed does not need to engage. And the entity offering the support does not get to require.
Not sure if the photos are yours or Tara Faul’s but these images are an important supplement to your message.
The man with new pants and shoes and a blanket over his head. The woman with the cat, the love bracelet, and multiple (presumably unopened) hygiene bags.
So many humans on the street getting stuff from unconnected “services” that gets lost without the structure and human connection that helps them hold it together.
Thanks for writing about a tough problem. The best solution is short term civil commitment in local hospitals which litigates the liberty interests of the severely mentally ill versus community interests for safety, civility, the capacity to intervene for the humane welfare of those who are severely mentally ill, and beauty in the public square. This will get those who are severely ill help for up to six weeks, the opportunity to get clean, fed, housed temporarily, talked to, sometimes detoxed, sometimes medicated, and to receive care for physical afflictions as well. No one wants to care for these people. The legal profession has advocated for them rotting with their rights on which is what we see daily on the streets. For years the legal profession has buried its head in the sand not wanting to address this public emergency. The medical profession sees them as obstinant, non compliant, sometimes aggressive, and so complex medically and psychiatrically that it is too much for them to even consider treating. That is why they need confinement involuntarily in local hospitals, that have access to other medical specialists, can be managed by psychiatrists on psychiatric units. The police want no part of trying to take them to a hospital when they refuse to go because they risk their lives. Remember they are armed with needles that the county passes out to them daily which can be used to stick officers and possibly infect them. Why would the police take these severely ill people to the hospital when they will be released in a few days and back on the street. The prosecutors would like to refer them for a meaningless psychiatric evaluation or better to have them get sent to the state hospital for interminable evaluations just to get them off the streets. Who wants to put these people in jail when they break public laws? First you have to get them to jail which is very dangerous and might take six officers who risk getting injured. Then the prosecutor won't charge them or jail them. It is easy to see why people would just want to house them, but that will fail because they will likely burn and destroy and not follow any treatment recommendations.
I am not against approaching this problem from all kinds of angles. Compulsive responsible outreach to try and get their cooperation, philanthropic housing for those who are severely ill after hospitalization and need 24/7 caregivers, assertive case management through local community centers, detox on demand for those who voluntarily request it, punishment and jail time for those who break public laws. With the best of efforts, many of these people will still chose a lifestyle that shows a disregard for personal and social responsibility. We need a structure to deal with them, persistent efforts to get them cleaned up and mentally healthier with brief hospitalizations, and an intervention-oriented police capacity. It helps not to see them as victims, but as those who can choose health and reasonable social conformity. Ultimately, our forceful efforts should be seen for what they really are, which are interventions for the public good, and stop with the phony virtue. The expectation should be that these people should get it together both personally and socially here. We should foster that choice, though ultimately change is up to them. When they chose wrong there should be some consequences. As you know I am totally opposed to long term hospitalization as these individuals get worse with long term institutional care. No more going back to warehousing the severely mentally ill.
Have the local officials whose beliefs and decisions have made housing first a scandalously expensive failure ever been asked to account for the results in a way that wouldn’t let them dodge responsibility? If I had a list of names, office contact information and vetted talking points, I’d gladly do it in writing.
This is the most comprehensive and compassionate article of yours and as someone who is a year clean from substance use disorder and still working to improve my home status, I really appreciate you completing the discussion with a solution.
The hardest thing to accept is: you can’t make people do anything. The services have to be voluntary. I love the programs use incentives and require mental health services. The concept makes complete sense except you can’t force people in our free will society to combat their trauma or financial health. Force them to take medication, stop using substances or stop drinking. all there is to do is get them housed and meet people where they are at emotionally until they feel safe to eventually use the services. It’s really an overwhelming process going from homeless, traumatized addict to an emotionally stable housed person.
No one is truly free to make a choice when driven by mental illness and drug and/or alcohol addiction. We must lower the bar on civil commitment, take the money now granted to non-profits, which mainly pay their staff high salaries rather than cure homelessness, and build lock-down facilities where psychotherapy, drug rehab treatment, job skills, nutrition and so forth are provided to the homeless. It seems that even with the current criteria for civil commitment, many would be determined to be incapacitated enough to be taken in to such places where the patient would actually have a chance to get well. Some patients would resist but others would accept it and gradually gain a bit more freedom than those that resist. It's not realistic or compassionate to act as if someone in an irrational state of mind will make healthy responsible choices. Deinstitutionalization led to this crisis and many other factors such as state sponsored enabling feeds it. Handing out supplies merely helps the addicts stay homeless, keeping them alive to eventually waste away from self destructive lifestyles that also negatively impact those living around them and the environment.
Which grifting NGO do you work for?